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General NPI Number Information
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NPI Number | 1144456658
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Entity Type | Organization
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Legal Business Name | PILSEN DENTAL GROUP
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Dates
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Enumeration Date | 06/10/2009
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Last Update Date | 06/10/2009
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Provider Practice Location Address
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Address Line | 1859 S BLUE ISLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60608-3012
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Country | US
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Telephone | 131-266-6556
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Fax |
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Provider Business Mailing Address
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Address Line | 1859 S BLUE ISLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60608-3012
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Country | US
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Telephone | 131-266-6556
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRIS TSALIAGOS
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Credential | DDS
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Telephone | 13126665560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 19023116
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License Number State | IL
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